Provider Demographics
NPI:1033608898
Name:MCMUNN, PATRICK E
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:E
Last Name:MCMUNN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-0490
Mailing Address - Country:US
Mailing Address - Phone:304-517-6048
Mailing Address - Fax:
Practice Address - Street 1:43 S STREETCAR WAY
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385
Practice Address - Country:US
Practice Address - Phone:304-745-5065
Practice Address - Fax:304-745-5067
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV979101YM0800X
FLTPPY2991103T00000X
WV1374103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health